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Abdominal lymphatic malformations in children: case series
Carmine Noviello1, Alfonso Papparella1, Mirko Bertozzi2
1Pediatric Surgery Unit, Department of Woman, Child, General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples.
Insights
Lymphatic malformations (LMs) in children often affect the abdomen. Management varies, with treatments including conservative care, laparoscopic excision, and laparotomy, aiming to preserve function and prevent complications.
Area of Science:
- Pediatric Surgery
- Vascular Malformations
- Congenital Abnormalities
Background:
- Lymphatic Malformations (LMs) are benign congenital anomalies of the lymphatic system.
- Abdominal LMs, particularly in the mesentery and omentum, are common in pediatric patients.
- Current management strategies for pediatric abdominal LMs lack a standardized approach.
Purpose of the Study:
- To review the diagnosis and management of abdominal Lymphatic Malformations in children.
- To evaluate the effectiveness of different treatment modalities for pediatric abdominal LMs.
- To highlight the importance of individualized treatment plans for these benign malformations.
Main Methods:
- Retrospective case series of 7 pediatric patients with abdominal Lymphatic Malformations.
- Diagnostic tools included abdominal ultrasound and Magnetic Resonance Imaging (MRI).
- Laparoscopy was utilized for diagnostic purposes in select cases.
Main Results:
- Patients ranged from newborn to 14 years old, with incidental diagnosis or presentation due to abdominal pain.
- Treatments comprised conservative management (1), laparoscopic excision (3), and laparotomic excision (3).
- Recurrence was noted in one case, requiring integrated treatment; bowel obstruction occurred post-excision in another.
Conclusions:
- Abdominal Lymphatic Malformations in children present a management challenge due to varied presentations and outcomes.
- Treatment goals focus on maintaining organ function, aesthetic integrity, and complication control.
- An individualized approach, tailored to each patient's specific condition, is crucial for optimal management.
Abstract:
Lymphatic Malformations (LMs) are benign congenital malformations of the lymphatic system that commonly involve the abdomen in children (mesentery of the small intestine and omentum). The management of these malformations is not unique. 7 children with different ages (range: newborn to 14 years), diagnosis was incidental in some cases, while in others for abdominal pain. All patients underwent abdominal ultrasound and Magnetic Resonance Imaging (MRI). Laparoscopy for diagnosis was useful in 4 cases. Treatment was: conservative in 1 child, laparoscopic excision in 3 patients, laparotomic excision in 3 cases. At follow up we observed recurrence in a case that required integrated treatment and bowel occlusion after excision in 1 case. This benign malformations may not cause any symptoms to patient. The goal of treatment is to maintain organ function, preserve aesthetic integrity and complications control. Management of these patients could be varied: the best approach should be evaluated on the basis of the patient.
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